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[Is the diagnosis of Stener's lesion echograph-dependent? A series of 25 gamekeeper's thumb].

Acute injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is a condition frequently seen by hand surgeons. Most can be treated conservatively except in the presence of a Stener lesion, when surgical treatment is necessary. What is difficult is to obtain the diagnosis of the Stener lesion. Some authors have proposed the use of echography, because sensitivity and specificity can reach 100%. The goal of our study was to demonstrate that the quality of echography depends upon the type of device used. Our retrospective series contained 25 gamekeeper's thumbs studied from March 2005 to March 2007. The first echograph, a Toshiba Ecccocee SMA-736SA-7.5MHz (ECHO 1) was used for the first 18 patients. The second one, a Toshiba APLIO SSA-700A/SSA-770A (ECHO 2) was used for the following six patients. It was equipped with a "tissue harmonic imaging" mode. ECHO 1 was inaccurate in 30% of cases in detecting the presence or absence of a Stener lesion. In contrast ECHO 2 enabled the echographer to be confident in diagnosing the presence or absence of a Stener lesion and peroperative findings or clinical result at review confirmed all the data obtained by ECHO 2. Echography is useful to look for a Stener lesion in the emergency situation because it is available, cheap, non-invasive, and dynamic. Echography is "echographer-dependent", but also "echograph-dependent". Our study revealed the advantage in using an echograph with "tissue harmonic imaging".

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